Changes in legislation for the Prescribed List

Learn about legislation changes to the Private Health Insurance Act 2007 and related instruments that will give effect to the Prescribed List Reforms.

What the reform is about

We are amending legislation for the Prescribed List to:

  • help clarify the purpose, definition, and scope
  • update the cost recovery arrangements
  • improve post-listing scrutiny including and enhanced program of utilisation reviews
  • establish a compliance program.

Stages

We will do this through 3 stages.

In stage 1, we:

  • changed the name from 'Prostheses' to 'Medical Devices and Human Tissue Products' – this better reflects the purpose and the types of products eligible for inclusion on the PL
  • included new definitions for 'medical device' and 'human tissue product' that align with those in TGA legislation
  • included statutory authority for the Minister for Health and Aged Care to establish fee for service cost recovery arrangements –these are consistent with the Australian Government Charging Framework.

In stage 2 we established the provisions for the revised cost recovery arrangements and listing criteria in relevant legislative instruments.

In stage 3 we will introduce compliance, assurance and information sharing measures.

Timeline

Stage 1 and 2 are complete. The following legislative changes commenced 1 July 2023:

We are currently considering stakeholder feedback about the proposed stage 3 legislative provisions.

Past activities

DateActivity
13 October 2023Stage 3 – webinar update on proposed measures for compliance, assurance and information sharing
12 July to 10 August 2023Stage 3 – consultation about compliance, assurance and information sharing measures
1 July 2023Private Health Insurance amendments and Rules came into effect
28 June 2023Stage 2 – released stakeholder feedback report about listing criteria and cost recovery arrangements
16 March 2023Stage 1 – Private Health Insurance Act amendments received Royal Assent
20 March to 1 May 2023Stage 2 – consultation about listing criteria and cost recovery arrangements
8 February 2023Stage 1 – released stakeholder feedback report
15 September 2022Stage 1 – consultation about the proposed changes to PL legislation
Date last updated:

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